Stroke and Deep Venous Thrombosis Complicating Intravenous Immunoglobulin Infusions

Katz, Kenneth A.; Hivnor, Chad; Geist, David E.; Shapiro, Michael C.; Ming, Michael E.; Werth, Victoria P.

doi:10.1001/archderm.139.8.991

Cited by 38 publications

(26 citation statements)

References 14 publications

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“…From this retrospective analysis the incidence of stroke associated with IGIV therapy was estimated at 0.6%. In addition, at least 13 other patients have been described in case reports [27,[70][71][72][73][74][75][76][77][78][79]. Several different powder and liquid IGIV preparations have been associated with the development of stroke.…”

Section: Strokementioning

confidence: 99%

“…In addition, slightly more than one-half of the patients were receiving their first cycle of IGIV. Importantly, many patients who developed stroke had significant predisposing risk factors including a history of a prior stroke [73], carotid artery stenosis [73,76], chronic hypertension [77], and hypercoagulable states such as polycythemia vera [71].…”

Section: Strokementioning

confidence: 99%

See 1 more Smart Citation

Adverse events associated with intravenous immunoglobulin therapy

Hamrock

2006

International Immunopharmacology

147

136

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Section: Strokementioning

confidence: 99%

Section: Strokementioning

confidence: 99%

Adverse events associated with intravenous immunoglobulin therapy

Hamrock

2006

International Immunopharmacology

147

136

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“…The authors noted that all patients had vascular risk factors, especially hypertension, and that thrombosis occurred concomitantly with the rise in platelet count [2]. Since then, case reports and case series have been published describing both arterial thrombosis (stroke [3][4][5][6][7][8][9][10][11][12][13][14][15][16], myocardial infarction [3,[17][18][19][20][21][22][23][24][25]) and venous thrombosis (deep vein thrombosis and pulmonary thromboembolism [7,8,12,[26][27][28][29][30][31][32][33][34]) following IVIg administration. These reports prompted the US Food and Drug Administration (FDA) in 2002 to add a precautionary statement to the labeling of IVIg products [35].…”

Section: Introductionmentioning

confidence: 99%

Venous and arterial thrombosis following administration of intravenous immunoglobulins

Paran¹,

Herishanu²,

Elkayam³

et al. 2005

Blood Coagulation &Amp; Fibrinolysis

125

118

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Thrombotic events are an increasingly recognized complication of treatment with intravenous immunoglobulins (IVIg). We aimed to define clinical characteristics, risk factors and outcome for venous thrombosis as opposed to arterial thrombosis following administration of IVIg. Six patients with post-IVIg venous thrombosis were identified at our institution. In addition, a review of the literature revealed 65 reported cases. Arterial thrombosis (stroke and myocardial infarction) was four times more common than venous thrombosis (deep vein thrombosis and pulmonary embolism). The incidence rate was estimated at 0.15-1.2% per treatment course, but the large increase in reported cases in 2003 suggests that the true incidence may be significantly greater. The following differences were found between arterial and venous events: arterial thrombosis occurred early after IVIg administration (49% within 4 h, 77% within 24 h) and was associated with advanced age and atherosclerotic vascular disease; venous thrombosis occurred later (54% more than 24 h after IVIg administration) and was associated with factors contributing to venous stasis (obesity and immobility). Thirteen patients died (mortality 20%), 11 of whom had arterial thrombosis. In conclusion, IVIg-associated thrombosis is more common than previously recognized, and is associated with significant mortality. The different characteristics of arterial and venous events may reflect different pathophysiological mechanisms. A better understanding of these mechanisms should aid in defining a risk-benefit ratio for the individual patient.

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“…Risk of developing a venous thrombotic complication following IVIG is increased in patients who are elderly, have renal impairment, pre-existing vascular disease, paraproteinemia, hyperlipidemia, immobilization and who receive high IVIG doses and rapid infusions [11,12,20,22,30]. Standard thrombosis risk factors such as hypertension, diabetes mellitus, and ischemic heart disease are also relevant to IVIG recipients [11].…”

Section: Arterial and Venous Thrombosismentioning

confidence: 99%